This is the second time now that my clinical experience is being short-changed by someone's vacation. The first time was two weeks ago, when I was supposed to be following a doc around the ICU. However, he was in Europe, and I ended up spending the week in the clinic with his PA - he was a nice guy, but going from high autonomy in the previous clinic to nothing of the sort in this one wasn't pleasant at all. The second time begins on Wednesday - I'm supposed to be rotating with a pulmonologist this week, but he's heading to South Africa for the world cup. Thus am I once more relegated to the outpatient clinics.
On to the Dichotomy. For the past week in the ICU, I was rotating with a doc at Cedars Sinai, the hospital recently purchased by the University of Miami Miller School of Medicine. This morning I met the aforementioned pulmonologist at the famously financially failing Jackson Memorial Hospital. I'd expected them to be relatively similar, given the fact that they're literally across the street from each other, but such was not the case. Though the floor on which we rounded was a step down from the ICU, it seemed to me that these patients were staring Death in the face, wondering who'd be the first to flinch.
There was a young woman who'd had a septic, embolic stroke and was now effectively paralyzed, though she was getting better. There was the older man in chronic liver failure, who was essentially non-responsive. There was another young woman with atrial-fibrillation and such severe GI bleeding that she was anemic and on the cusp of transfusion (the healthiest patient). There was a young AIDS patient whose liver failure resulted in the anasarca that I blogged about a while ago; he had an altered mental status from the hepatic failure. There was a young man who'd dived into a swimming pool, cracking his 7th cervical vertebrae, and is now on the cusp of quadriplegia. Next door to him was a young man - just a kid, really - who'd busted his head in a motorcycle accident, had no insurance, and so had lain in his hospital bed for 2 years, unable to move.
Then we hopped in the doc's BMW SUV and drove across the street to Cedars. It's like one is the fair and popular, new and advanced sibling, and the other is the dark, secretive, old-fashioned older brother. However, that younger, fair sibling is arrogant and spoiled- for some reason, I couldn't put my finger on it before. There's such an air of self-importance and arrogance at Cedars - it's generally from the younger folks working there; I can't name anyone specifically. I just feel as if the hospital is looking down it's nose at me - and everyone else - which probably isnt' fair, because I can't cite a single definite example; that's just my perception. It was different at Jackson - old Jackson. I don't mean to imply that they were all bubbly, they were about business; but I just felt so much more....comfortable at Jackson. At we left the floor, I glanced at the portraits of all of the interns in internal medicine who'd begun in 2006. The first thought of my head was "I could be there" - and I've never entertained any ideas of residency at Cedars.
Cedars is definitely newer, and the floor we were on in Jackson looked like it hadn't had a new coat of paint since the eighties. However, Jackson is a bit more advanced; they've got more toys and the only trauma center in Miami. Am I morbid? Is there something wrong with me that I loved it? I feel like if I do a residency at someplace like that, I'll be able to handle anything. I guess that's why "old-school" has positive connotations, and the opposite doesn't.
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